Provider Demographics
NPI:1144691130
Name:SHOOK, GARRETT KENWORTHY
Entity type:Individual
Prefix:
First Name:GARRETT
Middle Name:KENWORTHY
Last Name:SHOOK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 W ROYALE DR APT 3B
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-2279
Mailing Address - Country:US
Mailing Address - Phone:765-238-8011
Mailing Address - Fax:
Practice Address - Street 1:1811 W ROYALE DR APT 3B
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-2279
Practice Address - Country:US
Practice Address - Phone:765-238-8011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-15
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer